Erectile dysfunction (ED), also called impotence, is an inability to obtain or maintain an erection sufficient for intercourse. This is different from problems with ejaculation (anejaculation) or problems getting an orgasm, (anorgasmia) as well as having a low interest in sex (decreased libido).
There are many causes including problems with the blood supply to the penis, problems with the nerves feeding the penis and psychological problems. Occasionally a deficiency in a hormone such as testosterone can cause erectile dysfunction. Many medications can cause erectile dysfunction including some anti-hypertension medications, medicines for depression and anxiety, as well as some medicines used to treat prostate cancer.
Fortunately, for patients with erectile dysfunction, multiple medical and surgical options are available. In patients who have a hormonal deficiency in testosterone causing their ED, testosterone supplementation can help.
But many patients with ED do not have a low testosterone as the primary cause of their ED. Prior to the introduction of Viagra, there were not many options that worked well, but since then a large majority of patients find that these class of medications known as phosphodiesterase-5 inhibitors work very well for them. Broadly speaking, there are three medications available for ED, Viagra (generic name is Sildenafil), Levitra (Vardenafil), and Cialis (Tadafil).
The first medicine that became available to the public is Viagra in 1998. Viagra has good data on its safety and effectiveness and comes in 3 doses 25mg, 50mg and 100mg. The second medication is Levitra. Levitra works very similar to Viagra and it also comes in 3 doses. Both Viagra and Levitra are typically taken about 1 hour before sex and the effects of the medications last about 6-8 hours. These medications will not give you an erection but make it more easy to get one. A newer sublingual type of Levitra, called Staxyn, dissolves under the tongue and may work quicker than the regular Levitra or Viagra.
The third medication for ED is Cialis. The effects of Cialis last s longer than either Viagra or Levitra, up to 24 to 36 hours. This does not mean that patients will have an erection for 24 to 36 hours, but it does mean that they are better able to have an erection for that period of time. Cialis also offers a low daily dose which patients can take as they would any other daily medication. This has equivalent efficacy to the higher dose of Cialis and for patients who have intercourse frequently enough, they do not have to remember to bring their medicine with them.
All three medications generally have similar set of side effects including some lightheadedness, dizziness, vision changes, as well as some GI upset and potentially facial flushing. If you also take a class of heart medications called nitrates you cannot take any of these medications. All are pretty well tolerated by patients, but it is important to talk to your doctor about whether the medication side effects are acceptable to you or not.
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